Scalp symptoms are common in everyday life. In addition to itching, a variety of symptoms are possible including burning, tenderness, pain, pins and needles, etc. Some patients find that symptoms seem to correlate with hair loss whereas some patients have concerns only about the symptoms and are not experiencing hair loss.
For some patients, symptoms are rare and occur every few months. For others, symptoms are present each and every day. Some patients wake up with symptoms whereas others ding their scalp feels fairly normal in the morning but worsens towards the end of the day. I refer to the second situation as “end of day scalp symptoms” (i.e. EODSS). There are millions of nerves on the scalp and these nerves all secrete chemical and respond to chemicals that come into the scalp from the blood stream and chemicals that are produced within the scalp itself. Some of these chemicals are part of the normal physiology of the scalp and some of these chemical are increased during states of inflammation, stress, or infection. All of these chemical have the potential to worsen scalp symptoms.
The exact reasons for EODSS is not clear but there are likely many reasons. The concentrations of dozens and dozens of different hormones, neurotransmitters and cytokines change from morning to bedtime. These all have the potential to impact the way our scalp feels. Cortisol and testosterone levels are high in the morning and drop in the afternoon. Melatonin levels increase in the evening. Even ‘core’ body temperature changes through the day - being lowest at 6 am and then peaking at round 6 pm to 9 pm. These changes all affect the events in the scalp.
EODSS are poorly researched and poorly studied. EODSS are not specific but may be more likely associated with certain conditions than others. A proportion of patients with inflammatory scalp disease in particular report EODSS. These include seborrheic dermatitis, psoriasis, scarring alopecia, scalp rosacea, burning scalp syndrome, and sensitive scalp syndrome. Some patients with depression and anxiety and some with shedding disorders also report EODSS.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887